Der Anaesthesist
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It may be presumed that in 1979, 150 maternal deaths will occur in obstetrics (0.27 per 1000) in the Fed. Rep. of Germany, 40% of which will be due to caesarean sections. From 30% to 50% of this maternal death rate, must be related in one or another aspect to general or local anaesthesia. ⋯ Anaesthesists as well as obstetricians should be aware of the increased maternal risk from general or local anaesthesia. The maternal risk should be minimized. This can either be achieved if experienced anaesthesists only are responsible for obstetric anaesthesia (general as well as epidural, spinal etc.) if anaesthesia (general as well as local) is not considered as a comfortable service only but a strictly indicated medical procedure, and if new methods are developed to overcome the particular maternal risk in some regard.
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Of 66 patients undergoing hypotensive anaesthesia for oto-rhino-laryngological surgery, a sufficient low-pressure state was obtained in only 72% of patients when nitroglycerine was used. The cumulative nitroglycerine-consumption varied between 4.0 and 98.6 mg (0.05-1.698 mg/kg body weight). In 40 cases a normal or weak nitroglycerine-effect was accentuated by dihydralazine and the extend and time course of the interaction were investigated. ⋯ A disadvantage of these combinations, occurring in several cases, was the decreased manoeuvrability of hypotension. The continuation of the long-term sodium nitroprusside-hypotension by using nitroglycerine was succesful. Even after nitroglycerine application longer than 3 hours (up to 6 hours) the acid-base-status remained normal.
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In five adult horned sheep long-term cerebro-spinal fluid pressure measurements were carried out before, during and after ten spinal-anaesthetics with the help of a canula which was fixed on the skull. In the lumbar subarachnoid space the pressure-course was recorded also, before and after the injection of local-anaesthetic. The following reproducible phenomena were found: Rapid pressure increase after injection, increase of cardio-respiratory oscillations and in two cases a sharp decrease of pressure after removal of the spinal needle. A connection between this and the cause of postural headache in man is postulated.